What is thrush?

Vaginal thrush is a common condition caused by a yeast infection in the vagina and surrounding area. The infection is usually from the yeast Candida albicans, but is also known as vulvovaginal candidiasis or more commonly candida . Candida lives harmlessly on the skin, in the mouth, gut and vagina and is normally kept under control by harmless bacteria. But sometimes conditions change and the yeast increases rapidly, causing symptoms of thrush. Most women suffer from an attack of thrush at some point in their life but it is most common in women in their thirties and forties, and in those who are pregnant. It is not clear why some women are more prone to thrush than others, but diabetes and conditions causing problems with the body’s immune system increase the likelihood of it occurring. Other potential triggers include wearing tight clothing (as this prevents natural ventilation), taking antibiotics, having chemotherapy or using products that irritate the vagina, such as vaginal douches or bubble bath. There is little evidence that using sanitary towels or tampons is a risk factor for developing thrush.

What are the symptoms of thrush?

Some women with thrush will not have any signs or symptoms, and will be completely unaware they have thrush. A cervical screening test may pick up the presence of thrush by chance.

In women, typical symptoms include:

  • vulval itching, soreness, redness and irritation,
  • a vaginal discharge, often white (like cottage cheese), this can be thick or thin but usually odourless
  • pain, or discomfort, during sex or when passing urine
  • redness of the vagina and vulva

In men, symptoms may be less noticeable than in women but include:

  • Discomfort, burning or itching at the tip of the penis or under the foreskin
  • Redness or red patches on the penis or under the foreskin
  • A thick or thin discharge, like cottage cheese, under the foreskin
  • Discomfort when passing urine

How is thrush diagnosed?

This is not a condition you should diagnose yourself - see your doctor if you think you might have symptoms of thrush. The diagnosis is usually made on the symptoms present but your doctor may also need to confirm the diagnosis with a test. .  This is a simple and painless procedure and involves using a simple cotton swab to take a sample of cells from the vagina or penis and sending it to the local laboratory for analysis. The test will also show if the symptoms are being caused by other common conditions, such as bacterial vaginosis or trichomonas. Because thrush is not viewed as a sexually transmitted infection, your partner will not need to be tested, or treated, for the condition unless they also have symptoms.

How is thrush treated?

If symptoms are mild, your doctor will usually recommend a short course of antifungal medicine specifically for treating thrush, usually for 1-3 days but if the symptoms are more severe, the treatment course will be longer. A variety of treatment options are available including tablets by mouth, pessaries (inserting them into your vagina)  or by using a cream.

Tablet antifungal treatment is typically fluconazole or itraconazole, and these can be prescribed or bought over the counter. They can often be extremely effective, and one tablet taken once may be enough to cure an attack of thrush. However, they can occasionally cause side effects including nausea and vomiting, diarrhoea or constipation and bloating. Pregnant or breastfeeding women are not usually prescribed these however because of the chance of them affecting a baby.

Intravaginal pessaries do not cause as many side effects as oral antifungal treatments, but they can be awkward and messy to use, can cause local irritation, and can damage latex condoms and diaphragms (Always take care when inserting a pessary using an applicator if you are pregnant because of the risk of causing injury to the cervix. In this situation insert them by hand instead). Creams can be used in addition to a pessary if there is localised redness and soreness around the vagina and vulva.

If you treat yourself using over the counter products, do not use them long term without talking to your doctor or pharmacist. If symptoms do not improve within 14 days, talk to your doctor or pharmacist. Always go back to see your doctor if symptoms recur and you are a teenager or over 60, if you are pregnant, or if you have previously suffered from a sexually transmitted infection. Symptoms that should always be checked out without delay include abnormal menstrual bleeding, lower abdominal pain, a bloodstained discharge, or vaginal ulcers or blisters.

What can I do to prevent thrush?

As well as using over the counter treatments such as creams, pessaries, or tablets, there are a number of other things that you can do to help ease thrush, including:

  • Washing your vaginal area with simple non-perfumed soap and water or water alone. Avoid using highly scented soaps, shower gels, vaginal deodorants, or douches.
  • If you find that latex condoms, spermicidal creams, and lubricants cause irritation avoid using them. Try using a non-allergenic condom.
  • Avoid wearing tight-fitting clothes made of artificial fibres such as nylon.
  • Whenever possible, wear cotton underwear and loose-fitting clothes rather than tight clothes.